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Foster JD. Nephrology in Veterinary Medicine. KIDNEY360 2023; 4:1641-1649. [PMID: 37840194 PMCID: PMC10695652 DOI: 10.34067/kid.0000000000000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
Veterinary nephrology is a specialized field of veterinary medicine providing a high level of care for animals with all types of kidney disease. Veterinarians complete extensive training to become board-certified in veterinary nephrology-urology. Companion animal nephrology is the most advanced field; however, all species are afflicted by a variety of renal disorders. Most naturally occurring animal kidney diseases have similar disorders found in people; where veterinary research is lacking, clinical management is often modified from standard of care in people. Veterinarians have become adept at scaling down procedures to safely perform them on dogs and cats weighing only a few kilograms. Advanced diagnostics (renal biopsy, cystoscopy, fluoroscopic studies, etc. ) and therapeutics (renal replacement therapy, interventional endourology, etc. ) are commonly performed within the practice of veterinary nephrology-urology. Collaboration between veterinary and human nephrologists may advance both disciplines and improve care for people and animals alike.
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Gabba L, Iannucci C, Vigani A. Hemodialysis as emergency treatment of a severe baclofen intoxication in a 3 kg dog. Vet Med Sci 2022; 9:43-46. [PMID: 36516306 PMCID: PMC9857140 DOI: 10.1002/vms3.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe the clinical efficacy and drug removal kinetics of hemodialysis (HD) as emergency treatment in a small size dog with severe baclofen intoxication. CASE DESCRIPTION A 2-year-old dog was presented in stupor to the emergency service a few hours after ingestion of up to 25 mg of baclofen. Medical stabilisation was attempted but was unsuccessful in improving the neurological condition and the patient rapidly progressed to coma. A 4-h session of HD was performed in emergency with near complete resolution of neurological signs and only mild disorientation by the end of the treatment. No adverse side effects occurred during HD. Baclofen concentration was measured serially during the session. Drug extraction ratio, clearance and mass removal by the dialyser were calculated. Dialytic elimination rate constant (Kd ) was seven times higher than the intrinsic elimination rate constant (Kintr ) and the half-life (t½) during HD was nearly nine times shorter than the endogenous one. NEW OR UNIQUE INFORMATION PROVIDED This is the first case report providing pharmacokinetic data associated with HD treatment of severe baclofen intoxication in a dog.
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Affiliation(s)
- Linda Gabba
- Division of Small Animal Emergency and Critical CareDepartment of Clinical Veterinary MedicineVetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Claudia Iannucci
- Division of Small Animal Emergency and Critical CareDepartment of Clinical Veterinary MedicineVetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Alessio Vigani
- Division of Small Animal Emergency and Critical CareDepartment of Clinical Veterinary MedicineVetsuisse FacultyUniversity of ZurichZurichSwitzerland
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Hoffman L, Londoño LA, Martinez J. Management of severe baclofen toxicosis using hemodialysis in conjunction with mechanical ventilation in a cat with chronic kidney disease. JFMS Open Rep 2021; 7:20551169211033770. [PMID: 34367653 PMCID: PMC8312170 DOI: 10.1177/20551169211033770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Case summary A 2-year-old castrated male domestic shorthair cat was presented for evaluation of acute and progressive neurologic signs 2-4 h after exposure to baclofen. The suspected ingested dose was 2.1 mg/kg. On admission, the cat was tetraplegic with stuporous mentation, and venous blood gas analysis showed mild hypercapnia (PvCO2 43.4 mmHg) raising concern for hypoventilation. Owing to the acute nature of the ingestion, severity of the clinical signs and reported history of chronic kidney disease, hemodialysis was recommended to remove the toxin. A 5 h hemodialysis session was performed using an intermittent platform without hemoperfusion. At the beginning of hemodialysis, worsening hypoventilation and hypercapnia (PvCO2 88.6 mmHg) required endotracheal intubation and manual ventilation initially, followed by mechanical ventilation. At the end of the dialysis session, the cat was breathing spontaneously and disconnected from the ventilator. The cat was ambulatory and alert 1 h after the end of dialysis. After an additional 12 h of monitoring, the cat had full return of neurologic function and was discharged from hospital. Serum baclofen concentration measured prior to, during and after hemodialysis showed a 77.7% reduction in baclofen levels immediately after hemodialysis. Relevance and novel information This is the first report of baclofen toxicity in a cat successfully treated with hemodialysis and mechanical ventilation simultaneously. Treatment with hemodialysis therapy and mechanical ventilation could be considered in cases of acute baclofen toxicosis to improve outcome and reduce the length of the hospital stay.
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Affiliation(s)
- Levi Hoffman
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
| | - Leonel A Londoño
- Department of Critical Care, Capital Veterinary Specialists, Jacksonville, FL, USA
| | - Jenifer Martinez
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
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Teichmann-Knorrn S, Doerfelt S, Doerfelt R. Retrospective evaluation of the use of hemodialysis in dogs with suspected metaldehyde poisoning (2012-2017): 11 cases. J Vet Emerg Crit Care (San Antonio) 2020; 30:194-201. [PMID: 32077221 DOI: 10.1111/vec.12934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/06/2018] [Accepted: 06/16/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate dogs treated with hemodialysis for severe metaldehyde intoxication and to compare them with conventionally-managed patients. DESIGN Retrospective study (2012-2017). SETTING University teaching hospital. ANIMALS Data from 18 dogs with severe metaldehyde intoxication were analyzed. Eleven dogs were treated with intermittent hemodialysis and 7 managed conventionally. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS Metaldehyde poisoning was diagnosed based on clinical signs and toxicological analysis or presence of turquoise material in the gastrointestinal content. Clinical signs, additional treatments, dialysis prescription, duration of anesthesia and hospitalization, complications, and outcome were documented. Results were analyzed by t-test, Mann-Whitney U-test, and Chi-square test. P < 0.05 was considered significant. Dialysis was performed for median (range) 180 min (150-420 min) with median of 2.28 L/kg (1.66-4.48 L/kg) blood volume processed. In the hemodialysis group, anesthesia was discontinued at a median of 3.0 hours (1.5-6.7 h) after starting dialysis. The conventional-group received general anesthesia for a median of 17.5 hours (7.0-30.5 h). No further anticonvulsive treatment was necessary for the hemodialysis group. Time to hospital discharge was shorter in dialyzed dogs (median 18 h; 15-41 h) compared to conventionally treated dogs (median 89 h; 61-168 h; P = 0.0014). Aspiration pneumonia was reported in 5 conventionally treated dogs and none of the dialyzed dogs (P = 0.001). Five dialyzed dogs developed hematoma at the dialysis catheter site. One dog in each group was euthanized. CONCLUSION Hemodialysis significantly decreases the requirement for anesthesia and length of hospitalization in dogs with metaldehyde intoxication. Aspiration pneumonia occurred less often in dialyzed patients. Prospective studies are warranted to confirm the clinical utility of hemodialysis in dogs with metaldehyde poisoning.
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Affiliation(s)
- Svenja Teichmann-Knorrn
- Department for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stefanie Doerfelt
- Department for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - René Doerfelt
- Department for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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Segev G, Cowgill LD. Treatment of acute kidney injury associated with cyclosporine overdose in a dog using hemodialysis and charcoal hemoperfusion. J Vet Emerg Crit Care (San Antonio) 2018; 28:163-167. [PMID: 29419935 DOI: 10.1111/vec.12694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/04/2016] [Accepted: 04/27/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the management of cyclosporine overdose using hemodialysis and hemoperfusion in a dog. CASE SUMMARY A 6-year-old, spayed female Australian Shepherd was presented for treatment of cyclosporine overdose and acute kidney injury. Five days prior to presentation, the dog had been diagnosed by its referring veterinarian with immune-mediated thrombocytopenia. Treatment was initiated with prednisone, but since no response was noted, azathioprine (50 mg PO q 24 h) and cyclosporine (6 mg/kg IV q 24 h) were added. On day 4, an overdose of cyclosporine (33 mg/kg IV) was administered accidentally. Upon presentation, serum biochemistry panel revealed azotemia [creatinine, 521.6 μmol/L (5.9 mg/dL); BUN, 59.3 mmol/L (166 mg/dL)], increased activities of liver enzymes, and hyperbilirubinemia. Due to the presumed diagnosis cyclosporine overdose and acute kidney injury, a combined hemodialysis and charcoal hemoperfusion treatment was planned. Hemosorba CH-350 charcoal hemoperfusion cartridge was placed in series upstream in the extracorporeal circuit from the hemodialyzer. A 3-hour treatment was performed and a total of 0.74 L/kg of blood was processed. Pretreatment blood cyclosporine concentration was 960 nmol/L (1154 ng/mL) and decreased to 440 nmol/L (529 ng/mL) posttreatment (54% fractional reduction, 18% per hour). Thirty-one hours following treatment, blood cyclosporine concentration was 220 nmol/L (265 ng/mL; 1.5% decrease per hour). Twelve days following presentation to our hospital, the dog was euthanized due to lack of response to medical management. NEW OR UNIQUE INFORMATION PROVIDED Combined hemodialysis and charcoal hemoperfusion treatment can significantly reduce blood cyclosporine concentrations following acute intoxication or overdosage, and should be considered as an option for decontamination in such cases.
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Affiliation(s)
- Gilad Segev
- School of Veterinary Medicine, the Hebrew University of Jerusalem, Israel, Rehovot, Israel
| | - Larry D Cowgill
- the Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616
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Ahn JO, Jaung WJ, Won SH, Ryu MO, Song WJ, Jeon KO, Chung JY, Youn HY. Accidental afloqualone intoxication in two dogs. J Vet Med Sci 2018; 80:152-155. [PMID: 29142147 PMCID: PMC5797875 DOI: 10.1292/jvms.17-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Two dogs presented to the emergency service after accidental ingestion of afloqualone tablets, a muscle relaxant used for back pain in humans. Toxic effects of the drug in these dogs included vomiting, respiratory
depression, seizures, ataxia, bradycardia, and hematuria. Treatment consisted of fluid diuresis, furosemide, and propofol. Flumazenil, a gamma-amino butyric acid antagonist, was administered intravenously; however, it
was not effective in stopping the seizures in these dogs. Both dogs recovered with supportive treatment. To the authors’ knowledge, this is the first documented report of afloqualone intoxication in dogs.
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Affiliation(s)
- Jin-Ok Ahn
- Department of Veterinary Internal Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Won-Joung Jaung
- Department of Veterinary Internal Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Sang-Heum Won
- Department of Veterinary Internal Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Min-Ok Ryu
- Department of Veterinary Internal Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Woo-Jin Song
- Department of Veterinary Internal Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Kee-Ok Jeon
- Department of Veterinary Internal Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Jin-Young Chung
- Department of Veterinary Internal Medicine and Geriatrics, College of Veterinary Medicine, Kangwon National University, Chuncheon 200-701, Republic of Korea
| | - Hwa-Young Youn
- Department of Veterinary Internal Medicine and Institute of Veterinary Science, College of Veterinary Medicine, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
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Londoño LA, Buckley GJ, Bolfer L, Bandt C. Clearance of plasma ivermectin with single pass lipid dialysis in 2 dogs. J Vet Emerg Crit Care (San Antonio) 2017; 27:232-237. [PMID: 28117946 DOI: 10.1111/vec.12581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 06/01/2015] [Accepted: 08/11/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the use of single pass lipid dialysis (SPLD) for treatment of ivermectin toxicosis in 2 Australian Shepherd dogs with the ABCB1-1Δ gene mutation. CASE SERIES SUMMARY Two Australian Shepherd dogs were presented for treatment of ivermectin toxicosis. Dogs were initially treated with intravenous lipid emulsion and supportive care, without improvement of clinical signs. They both developed respiratory paralysis and required mechanical ventilation. In order to increase the clearance of circulating ivermectin, SPLD was performed using dialysate containing 5% lipid. Blood samples were obtained immediately before and after dialysis and analyzed for serum ivermectin concentration. Ivermectin reduction ratio was calculated at 29% and 39% for each dog, respectively. When compared to intrinsic total body ivermectin clearance, only the second dog had a relative improvement of plasma clearance following SPLD. Both dogs were confirmed to be homozygous for ABCB1-1Δ gene mutations. Both dogs remained ventilator dependent for several days and ultimately made a full recovery. NEW OR UNIQUE INFORMATION PROVIDED SPLD may be an adjunctive detoxification strategy for highly lipophilic toxins such as ivermectin.
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Affiliation(s)
- Leonel A Londoño
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32611
| | - Gareth J Buckley
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32611
| | - Luiz Bolfer
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32611
| | - Carsten Bandt
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32611
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Fox CM, Daly ML. Successful treatment of severe baclofen toxicosis initially refractory to conventional treatment. Clin Case Rep 2016; 5:44-50. [PMID: 28096989 PMCID: PMC5224782 DOI: 10.1002/ccr3.736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/28/2016] [Accepted: 09/28/2016] [Indexed: 11/05/2022] Open
Abstract
After ingesting a dose of baclofen thought to be lethal, a patient with severe neurologic signs was successfully managed despite initially being refractory to treatment. Patients with persistent neurologic abnormalities may still have an excellent prognosis despite lack of initial response. Additionally, we present a potential case of benzodiazepine withdrawal.
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Affiliation(s)
- Christine M Fox
- Critical Care Department BluePearl Veterinary Partners New York City New York USA
| | - Meredith L Daly
- Critical Care Department BluePearl Veterinary Partners New York City New York USA
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Mauser EL, Puschner B, Reese S, Hartmann K, Doerfelt R. Evaluation of the in vitro efficacy of hemodialysis, hemoperfusion, and the combined approach on the removal of metaldehyde from canine plasma. J Vet Emerg Crit Care (San Antonio) 2016; 26:516-23. [DOI: 10.1111/vec.12487] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/28/2014] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Elisabeth L. Mauser
- Clinic of Small Animal Medicine; Ludwig-Maximilians-University; Munich 80539 Germany
| | - Birgit Puschner
- Department of Molecular Biosciences, California Animal Health and Food Safety Laboratory, School of Veterinary Medicine; University of California; Davis CA
| | - Sven Reese
- Department of Veterinary Sciences, Institute of Veterinary Anatomy; Ludwig-Maximilians-University; Munich 80539 Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine; Ludwig-Maximilians-University; Munich 80539 Germany
| | - René Doerfelt
- Clinic of Small Animal Medicine; Ludwig-Maximilians-University; Munich 80539 Germany
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Poisoning of dogs and cats by drugs intended for human use. Vet J 2014; 203:52-8. [PMID: 25475169 DOI: 10.1016/j.tvjl.2014.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 12/12/2022]
Abstract
One of the main causes of poisoning of small animals is exposure to drugs intended for human use. Poisoning may result from misuse by pet owners, off-label use of medicines or, more frequently, accidental ingestion of drugs that are improperly stored. This review focuses on classes of drugs intended for human use that are most commonly involved in the poisoning of small animals and provides an overview of poisoning episodes reported in the literature. To perform this review a comprehensive search of public databases (PubMed, Web of Science, Scopus, Google Scholar) using key search terms was conducted. Additionally, relevant textbooks and reference lists of articles pertaining to the topic were reviewed to locate additional related articles. Most published information on small animal poisoning by drugs intended for human use was from animal and human poison control centres or from single case reports. The dog was the species most frequently poisoned. The major drugs involved included analgesics (nonsteroidal anti-inflammatory drugs), antihistamines (H1-antihistamines), cardiovascular drugs (calcium channel blockers), central nervous system drugs (selective serotonin reuptake inhibitors, baclofen, benzodiazepines and zolpidem), gastrointestinal drugs (loperamide), nutritional supplements (vitamin D and iron salts) and respiratory drugs (β2-adrenergic receptor agonists).
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Edwards P, Shihab N, Scott HW. Treatment of a case of feline baclofen toxicosis with intravenous lipid therapy. VETERINARY RECORD CASE REPORTS 2014. [DOI: 10.1136/vetreccr-2014-000059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Paul Edwards
- Abington Park Veterinary Group427 Wellingborough RoadNorthamptonNN1 4EZUK
| | - Nadia Shihab
- Southern Counties Veterinary SpecialistsUnit 6 Forest Corner Farm, HangersleyRingwoodHampshireBH24 3JWUK
| | - Harry W. Scott
- Southern Counties Veterinary SpecialistsUnit 6 Forest Corner Farm, HangersleyRingwoodHampshireBH24 3JWUK
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Bates N, Chatterton J, Robbins C, Wells K, Hughes J, Stone M, Campbell A. Lipid infusion in the management of poisoning: a report of 6 canine cases. VETERINARY RECORD CASE REPORTS 2013. [DOI: 10.1136/vetreccr.101036rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- N. Bates
- Veterinary Poisons Information ServiceMedical Toxicology and Information ServicesMary Sheridan HouseLondonSE1 9RYUK
| | - J. Chatterton
- Grove Veterinary Centre2 Hibbert Street, New MillsHigh PeakDerbyshireSK22 3JJUK
| | - C. Robbins
- Castle Vets Pet Healthcare Centre1 Tilehurst RoadReadingRG1 7TWUK
| | - K. Wells
- Kingfisher Veterinary PracticeSouth Road Vet CentreMountfield RoadTauntonSomersetTA1 3BQUK
| | - J. Hughes
- Blake Veterinary GroupShowground RoadBridgwaterSomersetTA6 6AJUK
| | - M. Stone
- RSPCA Bristol & District Branch48 Albert RoadSt PhilipsBristolBS2 0XAUK
| | - A. Campbell
- Veterinary Poisons Information ServiceMedical Toxicology and Information ServicesMary Sheridan HouseLondonSE1 9RYUK
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Khorzad R, Lee JA, Whelan M, Brutlag AG, Martin EP, Miyahara LT, Hovda LR. Baclofen toxicosis in dogs and cats: 145 cases (2004-2010). J Am Vet Med Assoc 2013; 241:1059-64. [PMID: 23039981 DOI: 10.2460/javma.241.8.1059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify dogs and cats with baclofen toxicosis and characterize the patient population, clinical signs, and outcome. DESIGN Retrospective case series. ANIMALS 140 dogs and 5 cats with baclofen toxicosis. PROCEDURES An animal poison control center electronic database was reviewed from November 2004 through April 2010 to identify dogs and cats with baclofen toxicosis. Information on signalment, clinical signs, and amount of baclofen ingested was obtained. Clinical signs were categorized as CNS, gastrointestinal, general malaise, cardiovascular, respiratory, or urogenital. Follow-up communications were performed to determine overall outcome. RESULTS Dogs had a median age of 0.67 years (range, 0.1 to 15 years) and cats of 1 year (range, 0.7 to 16 years). Of 145 patients, 133 (92%) developed clinical signs of baclofen toxicosis. A total of 259 signs fell within defined categories: CNS (121/259 [46.7%]), gastrointestinal (69/259 [26.6%]), general malaise (27/259 [10.4%]), cardiovascular (23/259 [8.9%]), respiratory (14/259 [5.4%]), and urogenital (5/259 [1.9%]). For 68 dogs with known survival status, survival rate was 83.8% (57/68); of these dogs, the amount of baclofen ingested was known for 53 (46 survivors and 7 nonsurvivors). Amount of baclofen ingested was significantly lower in survivor dogs (median, 4.2 mg/kg [1.91 mg/lb]; range, 0.61 to 61 mg/kg [0.28 to 27.7 mg/lb]), compared with nonsurvivor dogs (median, 14 mg/kg [6.4 mg/lb]; range, 2.3 to 52.3 mg/kg [1.04 to 23.77 mg/lb]. Of 5 cats, 2 survived, 1 died, and 2 had unknown outcomes. CONCLUSIONS AND CLINICAL RELEVANCE Clinical signs of baclofen toxicosis occurred in most patients, with the CNS being the system most commonly affected.
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Affiliation(s)
- Roxanna Khorzad
- Section of Emergency and Critical Care, Angell Animal Medical Center, 350 S Huntington Ave, Boston, MA 02130, USA.
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Bates N, Chatterton J, Robbins C, Wells K, Hughes J, Stone M, Campbell A. Lipid infusion in the management of poisoning: a report of 6 canine cases. Vet Rec 2013; 172:339. [PMID: 23423482 DOI: 10.1136/vr.101036] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intravenous administration of lipid is a relatively new treatment in the management of toxicity from lipophilic compounds. It is used in human medicine in the treatment of toxicity from lipophilic local anaesthetics and cardiotoxic drugs and can result in dramatic improvement in clinical status. We present six cases of poisoning in dogs successfully treated with lipid infusion after ingestion of ivermectin (3), moxidectin (2) and baclofen (1). The dogs ranged in age from eight weeks to 14 years, and weighed 4-30 kg. Intravenous lipid therapy was started between six and eight hours and 22 hours after ingestion, and all the dogs responded well. In four dogs, there was clinical improvement within one hour; one had improved within two hours and the other within 4.5 hours of lipid administration. The only adverse effect of lipid infusion reported was mild swelling and pain after extravasation in one case which resolved with conservative management. All the dogs were discharged within 24-52 hours after exposure (7-46 hours after the start of lipid administration), and none developed any apparent sequelae.
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Affiliation(s)
- N Bates
- Veterinary Poisons Information Service, Medical Toxicology and Information Services, Mary Sheridan House, London SE1 9RY, UK.
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Urea kinetics and intermittent dialysis prescription in small animals. Vet Clin North Am Small Anim Pract 2011; 41:193-225. [PMID: 21251518 DOI: 10.1016/j.cvsm.2010.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hemodialysis improves survival for animals with acute kidney injury beyond what would be expected with conventional management of the same animals. Clinical evidence and experience in human patients suggest a role for earlier intervention with renal replacement to avoid the morbidity of uremia and to promote better metabolic stability and recovery. For a large population of animal patients, it is the advanced standard for the management of acute and chronic uremia, life-threatening poisoning, and fluid overload for which there is no alternative therapy.
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Abstract
Renal replacement therapies (RRT) are increasingly used for the treatment of acute and chronic kidney diseases as well as intoxications and accidental drug overdoses. These therapies offer a mechanism for the removal of toxic substances from the patient's blood and supplement the standard detoxification protocols. If instituted early, RRT can have a significant effect on the course of the toxicity; however, this process is not selective for the removal of only harmful products and can also result in the clearance of medications intended for therapeutic use.
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